Provider Demographics
NPI:1073572871
Name:PERINI SERVICES/SOUTHAMPTON MANOR LP
Entity Type:Organization
Organization Name:PERINI SERVICES/SOUTHAMPTON MANOR LP
Other - Org Name:SHIPPENSBURG HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:PERINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-745-8700
Mailing Address - Street 1:1710 UNDERPASS WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6979
Mailing Address - Country:US
Mailing Address - Phone:301-745-8700
Mailing Address - Fax:301-790-3094
Practice Address - Street 1:141 WALNUT BOTTOM ROAD
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-9005
Practice Address - Country:US
Practice Address - Phone:717-530-8300
Practice Address - Fax:717-530-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA035002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015509080002Medicaid
395964Medicare Oscar/Certification
PA395964Medicare ID - Type Unspecified